Every patient is verified before the first visit — coverage, copay, deductible, and whether the plan is one you can actually bill.
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Member ID
Terminated coverage, a Medicare Advantage plan hiding behind a Medicare card, a payer that's temporarily down — the check catches billing problems while they're still booking problems, not denials.
1EG4-TE5-MK72
What the check found
On file
Medicare
Actually enrolled
Humana Medicare Advantage
HMO vs. PPO, Medi-Cal, commercial — every plan is identified in real time, and you configure which ones your practice takes. Everything else is filtered out before it reaches your schedule.
Plans your practice accepts
The patient sees what this visit costs them while they book it. You see the same plan in the chart with the detail you need to bill it — what's left on the deductible, how far into the out-of-pocket max they are, and how many visits the plan allows. Nobody is surprised by a bill.
Aetna PPO
What your patient sees while booking
What you see in the chart
Coverage doesn't hold still. A patient switches carriers mid-plan-of-care, ages onto Medicare, or their plan simply goes inactive — and nobody tells you. Benefits are re-checked before every visit, so you find out the day it happens instead of billing for weeks or months and learning about it from a stack of denials.
Coverage checks
Medicare as primary and the Supplement behind it are both verified, so the secondary is known before you bill rather than discovered afterward. Dual-eligible patients are identified as Medicare and Medicaid, therapy-cap usage is tracked per patient, and cost-sharing rules are applied to what the patient is shown.
Medicare details
Because the plan is re-checked before every visit, the claim always knows who to bill and what the patient owes. Finish the visit, submit it, and the claim is built against the right payer — whether you're billing in-network or filing out-of-network on the patient's behalf.
Visit submitted